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CAD/CAM international magazine of digital dentistry

case report _ patient-specific abutments I struction. This technology is now offered by various manufacturers. _Objective Our objective as specialists must not only be the replacement of a lost tooth as soon as possible after extraction,butalsobethesatisfactionofourpatients’ constantly increasing aesthetic demands—with re- gard to the anterior tooth area in particular—through suitableboneandsoft-tissuemanagement. Thus, even when the implant is being inserted, preference must be given to keeping the crestal bone structure as unchanged as possible because in this way the interdental papilla and the peri-implant gin- givacanbemaintainedinthelongterm.4 _Case presentation The realisation of the patient’s wish was facili- tated in the following case in close collaboration with Zahntechnik Zentrum Eisenach after the tooth re- placement was firmly in place, despite alveolar bone loss and difficult gingival conditions (Figs. 1 & 2). The surgicalprocedureforthiscaseisdescribedinLiebaug andWu(2011).5 The anatomically formed and bevelled OsseoSpeed TX Profile implants (DENTSPLY Implants) were used in regions#12,11,21and22.Theseimplantsarespecially designed to preserve the marginal bone in an alveolar ridgewithangularatrophybothvestibularlyandorally, that is, 360 degrees around the implant.6 Restoration with patient-specific ATLANTIS abutments (DENTSPLY Implants)wasplannedinordertocompleteprosthetic restoration optimally after successful implantation and osseointegration. As described in Noelken (2011),7 the marginal bone can be preserved cheaply by the use of these implants, which are new to the dental market. Optimal soft-tissue support can be achieved withindividualisedmanufacturedabutments. _Challenge in terms of maxillary anterior tooth loss While replacing a missing tooth with an implant can now be considered routine, rehabilitation in the maxillary anterior region still represents a particular challenge for the treatment team. In addition to successfulosseointegrationoftheimplant,particular attention must be given to functional and aesthetic parameters to achieve a restoration that perfectly harmoniseswithnaturalteeth.8 _Prior to surgery: Addressing the patient’s wishes and providing information Thepatient’swishesmustalwaysbeconsideredbe- fore treatment begins. The patient should be offered clarificationpriortotreatment,particularlyindifficult initialsituationswithevidenthard-tissuelossandun- favourable gingival conditions. For forensic reasons, photographic documentation of the initial situation is an indispensable aid in addition to diagnostic casts. It should also be used as the basis for discussion with thepatient. If bone on the labial side has already been lost and theoptimalbonecontourshavenotbeenrestoredwith a bone transplant, achieving the desired aesthetic resultisneverthelessoftennotdifficult. In terms of this 67-year-old patient, the implants were exposed by incision to the middle of the alveolar ridge from regions #12, 11, 21 and 22 after a four- monthhealingphase(Fig.3). Fig. 4_Condition immediately after the healing abutments were placed (height of 2 mm). Fig. 5_Three weeks of good healing and moulding of the peri-implant soft tissue. Fig. 6_Schematic depiction of the Conical Seal Design for a custom-fitted conical connection between the implant and abutment. Fig. 7_Abutments on the master cast with the gingival mask. Fig. 8_Virtual 3-D model for abutment planning below the subsequent crowns. Fig. 9_Virtual 3-D model for patient-specific abutment planning. Fig. 10_Occlusal view of the abutment and adjustment thereof. I 23CAD/CAM 4_2012 Fig. 5 Fig. 6 Fig. 8 Fig. 9 Fig. 10 Fig. 7 Fig. 4